Bone marrow failure in children with acute liver failure

Background: Aplastic anemia is a rare but well-recognized complication of a cute hepatitis and acute liver failure. The cause is unknown, and the condi tion is fatal without bone marrow recovery. Treatment includes immunosuppre ssion regimens or bent: marrow transplantation, The purpose of this study w as to investigate the incidence, cause, treatment, and outcomes of this dis order in children. Methods: Retrospective chart review of 75 patients with acute liver failure in a major pediatric liver center. Results: Eight patients had evidence of bone marrow failure. Of those, six had aplastic anemia, and two had transient bone marrow suppression. There w ere five buys, median age 57 months (range, 36-132 months). Two had parvovi rus B19, six had non-A, non-B, non-C hepatitis. Five underwent liver transp lantation: auxiliary in one, orthotopic in four. The interval between initi al symptoms and development of aplastic anemia and/or bone marrow suppressi on was 21 to 99 days (median, 39 days). Four patients with aplastic anemia received intravenous antithymocyte globulin (ATG) or antilymphocyte globuli n (ALG). Median recovery period of granulopoiesis was 62 days (range, 27-11 5 days). Two made a full recovery, one had my elodysplasia, and one with un responsive disease died of septic complications. Four did not receive ATG/A LG, two had aplastic anemia, and two had bone marrow suppression. Three und erwent liver transplantation, and all four resumed granulopoiesis. One chil d who underwent liver transplantation died of sepsis with chronic rejection . Median recovery of granulopoiesis was 99 days (range, 20-153 days). Conclusions: Bone marrow failure occurs in 10.7% of children with acute liv er failure. It sometimes occurs in association with non-A, non-B, non-C hep atitis and parvovirus B19 infection. Treatment with ATG/ALG is successful a nd is well tolerated in most cases.